经脐单孔多通道腹腔镜手术治疗良性肾脏疾病的初步体会

目的 探讨经脐单孔多通道腹腔镜手术治疗良性肾脏疾病的可行性和安全性.方法 2008年12月至2009年5月,应用Triport单孔多通道平台完成无功能肾切除1例、肾盂旁囊肿1例和单纯性肾囊肿去顶减压术11例.在脐上缘切开2 cm,开放切开法直接进入腹腔,置入Triport.使用5 mm一体式腹腔镜、可弯抓钳、可弯分离钳和传统腹腔镜器械完成操作.使用血管直线切割器离断肾蒂.无功能肾脏标本装袋后由切口取出,不留置引流管.结果 手术均顺利完成,未增加另外工作通道.其中肾切除术耗时85 min,出血50 ml;肾盂旁囊肿去顶术耗时110 min,出血30 ml;单纯性肾囊肿去顶术平均耗时35(25～55)min.术后平均住院2.8(2～5)d,术后均无明显手术瘢痕.结论 经脐单孔多通道腹腔镜手术治疗良性肾脏疾病创伤小、美容效果好,效果满意,在适应可弯器械后手术难度明显减低.     

CT在诊断乳房良性疾病中的应用

评价ＣＴ诊断乳房良性疾病的价值。方法４４例患者接受乳房ＣＴ扫描和钼靶摄片检查。对比分析这两种检查方法对乳房良性疾病的定位和定性准确性。所有病例经病理证实均为良性疾病。结果ＣＴ对乳房纤维瘤和乳房囊肿有明确诊断作用,对乳房深部病灶、乳房多发性多样良性病变的诊断优于钼靶摄片检查。     

Bronchial Artery Embolization for Hemoptysis Due to Benign Diseases: Immediate and Long-Term Results

Purpose: To clarify the immediate effect and long-term results of bronchial artery embolization (BAE) for hemoptysis due to benign diseases and the factors influencing the outcomes. Methods: One hundred and one patients (aged 34–89 years) received bronchial artery embolization with polyvinyl alcohol particles and gelatin sponge for massive or continuing moderate hemoptysis caused by benign pulmonary diseases and resistant to medical treatment. Results: After BAE, bleeding stopped in 94 patients (94%). The immediate effect was unfavorable in cases where feeder vessels were overlooked or the embolization of the intercostal arteries was insufficient. Long-term cumulative hemoptysis nonrecurrence rates after the initial embolization were 77.7% for 1 year and 62.5% for 5 years. In bronchitis (n = 9) and active tuberculosis (n = 4) groups, an excellent (100%) 5-year cumulative nonrecurrence rate was obtained. The rate was lower in groups with pneumonia/abscess/pyothorax (n = 8) or with pulmonary aspergillosis (n = 9) (53.3%, 1-year cumulative nonrecurrence). There were higher incidences of early recurrence among patients with massive hemorrhage or more marked vascularity and systemic artery–pulmonary artery shunt in angiography: however, these trends were not statistically significant Conclusions: BAE can yield long-term benefit in patients with hemoptysis due to benign diseases. Technical problems in the procedure had an impact on the short-term effect. The degree of hemorrhage or the severity of angiographical findings were not significant factors affecting the outcome. The most significant factor affecting long-term results was whether the inflammation caused by the underlying disease was medically well controlled.     

经尿道前列腺电汽化联合撬拨术治疗高龄前列腺增生症

目的探索微创手术治疗高龄前列腺增生症(benign prostatic hyperlasia,BPH)的安全有效新方法. 方法采用经尿道前列腺电汽化(transurethal vaporiyation of prostate,TUVP)联合撬拨术治疗80岁以上BPH 68例. 结果手术时间30～160 min,平均60 min,切除腺体重量12.5～98.5 g,平均37.6 g,术中出血量30～120 ml,平均65 ml,术后住院5～7 d,平均6 d.术后随访0.5～2年,国际前列腺症状评分由(23.5±4.2)分降至(6.5±2.1)分,生活质量评分由(4.6±0.6)分降至(2.2±0.2)分,最大尿流率由(8.7±4.3)ml/s升至(18.0±2.2)ml/s,剩余尿由(176.0±86.7)ml降至(12.2±2.4)ml.与术前相比,术后6个月均得到显著改善(P＜0.01). 结论 TUVP加撬拨术治疗高龄BPH安全有效,并发症少.     

Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: diagnosis and treatment

Objectives: To identify patients with benign paroxysmal positional vertigo (BPPV) among patients with severe traumatic brain injury (TBI) and to evaluate the effectiveness of the Particle Repositioning Maneouvre (PRM).

Design and methods: Eighteen months prospective study of 150 consecutive patients with severe TBI referred to an in-patients rehabilitation department.

Interventions: A structured interview emphasizing the possible presence of vertigo followed by a detailed neuro-otological examination. Patients diagnosed with BPPV were immediately treated with the PRM.

Main outcomes and results: BPPV diagnosis was based on a positive Dix-Hallpike positional test. PRM efficacy was determined by repeating the positional test 1 or 2 weeks after treatment. Twenty out of 150 (13.3%) patients complained about positional vertigo. The diagnosis of BPPV was confirmed in 10 patients. Signs and symptoms were completely relieved in six patients after a single PRM, while the other four patients needed repeated treatment for complete resolution of BPPV.

Conclusions: About half of the patients with severe TBI who complain about positional vertigo suffer from BPPV. These patients can be efficiently treated by physical maneouvres improving the rehabilitation outcome.     

True Solitary Pancreatic Cyst in an Adult: Report of a Case

The differential diagnosis of cystic neoformations in the pancreas is challenging. We report a case of a true solitary cyst of the pancreas in a 26-year old woman. Abdominal magnetic resonance imaging and computed tomography showed a unilocular neoformation in the head of the pancreas, without obstruction of Wirsung's duct. We excised the cyst and performed Roux-en-Y loop pancreaticojejunostomy, but the patient suffered recurrent acute pancreatitis from Wirsung's duct stenosis. Thus, a new Roux-en-Y loop pancreaticojejunostomy was successfully done 6 months later. Histologically, the cyst was lined by cuboidal epithelium, immunohistochemically positive to anti-carbohydrate antigen 19-9 antibodies. To our knowledge, only 11 cases of solitary true cyst of the pancreas in adults have been reported, so the characteristics of this unusual entity are not well known. We propose a scheme for the differential diagnosis of cystic neoformations of the pancreas, starting from the histopathological definition of a true solitary cyst.     

腹腔镜手术治疗卵巢良性肿瘤110例分析

目的:探讨腹腔镜手术治疗卵巢良性肿瘤的效果。方法:回顾性分析1996年4月至2008年8月我院应用腹腔镜手术治疗110例卵巢良性肿瘤患者的临床资料。结果:92例行腹腔镜下肿瘤切除术,18例行附件切除术。术后96例获随访6~60个月,1例术后1年复发,为同侧卵巢浆液性囊腺瘤;1例术后5年发生双侧卵巢乳突状浆液性囊腺癌;余术后均无复发及腹腔粘液瘤发生。结论:经过严格的术前筛查,腹腔镜手术治疗卵巢良性肿瘤安全、有效,值得推广应用。     

Extracranial radiosurgery—applications in the management of benign intradural spinal neoplasms

Stereotactic radiosurgery has enabled the delivery of higher doses of radiation and decreased fractionation due to improved accuracy. Spinal radiosurgery has been increasingly utilized for the management of metastatic extradural spinal disease. However, surgical resection remains the primary treatment strategy for intradural spinal tumors. Preliminary evidence suggests that radiosurgical ablation with stereotactic radiation for intradural spinal lesions may be efficacious in certain clinical scenarios. Local tumor control, pain relief, and improvement in neurologic function with minimal morbidity have been reported in short-term follow-up. However, long-term efficacy of radiosurgery in the management of intradural spinal neoplasms necessitates further validation. As extracranial radiosurgery is a newly evolving modality, a continuative review of the current literature is appropriate. Until a standardized therapeutic window of safety and efficacy can be determined, the recommendation of radiosurgical applications for benign spinal tumors should be reserved for carefully selected cases.     

两种经尿道前列腺切除术的疗效比较

目的比较经尿道钬激光前列腺剜除术和经尿道前列腺电切术治疗良性前列腺增生症的效果。方法前列腺增生症患者123例随机分为两组（剜除术组60例、电切术组63例）,分别行HoLEP和TuRP,监测、记录两组患者术前、术中及术后的相关临床指标,进行分析、对比。结果术前两组一般情况比较差异无统计学意义（P〉0．05）。剜除术组手术时间、术中冲洗液量较电切术组多,但术中出血量、术后出血量、膀胱冲洗时间、尿管留置时间均小于电切术组。术后随访1～6个月,两组IPSS、Qmax较术前均明显改善（P〈0．01）;剜除术组发生尿道狭窄3例,尿失禁1例,无阳痿发生;电切术组发生尿道狭窄5例、尿失禁2例、阳痿1例,两组间手术并发症发生率差异无统计学意义（P〉0．05）。结论剜除术治疗前列腺增生症,效果可靠,与电切术相比,具有出血少,术后恢复快等优点,值得进一步推广应用。     

PKRP与TURP治疗良性前列腺增生症的疗效比较

目的观察经尿道前列腺等离子切除术（PKRP）治疗良性前列腺增生症（BPH）的疗效及并发症,并与经尿道前列腺电切术（TURP）进行比较。方法回顾分析采用PKRP、TURP治疗的768例BPH患者,分别收集两组患者年龄、国际前列腺症状评分（IPSS）、剩余尿量（RUV）、最大尿流率（Qmax）、生活质量评分（QOL）、手术时间、术中出血量、术后尿管留置时间、住院天数、术后并发症发生率资料并进行统计分析。结果两组病例年龄、前列腺重量及术前IPSS、RUV、Qmax和QOL比较差异均无统计学意义（P〉0.05）。两组在手术成功率、平均住院时间、术后平均留置尿管时间、术中出血量和冲洗时间方面无统计学差异（P〉0.05）;两组在手术时间、并发症发生率方面有统计学差异（P〈0.05）。结论PKRP治疗BPH的近期临床疗效与TURP相当,临床上可根据患者情况和适应证选择不同方法,以获得更好的临床疗效。